Mom (78), has been changed from lexapro to Prozac today. She has kidney disease and dementia, but also compulsive behaviors.

I don't think so. I think they are responding to her symptoms.

It sounds as though you are hesitant to ask the questions that are on your mind. I was too, at first. I thought they were going to think that I was a horrible daughter for really not caring what various meds were going to do to mom's heart/kidneys/whatevers. A very wise geriatrician told me "at this point, you want to do the thing that relieves the most symptoms, while weighing the possible harm; but not avoiding the harm because at this point, she's got several fatal diseases". Or something like that. It's a matter of doing the "least bad thing" I feel.

For me, seeing my mom in physical pain or psychic distress are unacceptable. I will grant medical staff much latitude to relieve either of those conditions, whether or not the relief shortens my mom's life. I make sure that everyone who treats her knows that.

I would find out who made the change. I would call them say that you've noticed that Prozac has warnings about kidney damage and lack of safety in dementia patients (is that from the package insert, or is it from the ravings of the internet?). Ask why they think the change will be beneficial to your mom. Then decide if the risk is worth it.

My mom has dementia, and Chronic Heart Failure. I am praying that something else takes her before either one of those becomes too advanced; thus, I don't worry too much about side effects aside from diarrhea. If there is a med out there that calms her agitation and makes her feel at peace, I'll take the risks. But that's very much just my way of looking at things.

If an antidepressant is losing effectiveness over time, the MD may "rotate" to a different medication. Ask them if this was their rationale.

I work in the mental health field so I know those medicines and which have certain risks. And she has been on lexapro for 10 years so I had expected long before she went to nursing home- she's been there only since May. She has been battling ESLB and both her kidney disease and dementia are gaining speed with how they are advancing. She has gotten increasingly obsessive, and I am thinking that might be the catalyst for the change as lexapro doesn't really treat OCD. She is obsessed with her items being in a certain order and when she's having a good day, she will rearrange her items herself. If she's not up to it she demands the staff do it for her. She obsesses on getting her meds exactly the same time every time and starts pressing her alert button if it's not on the hour (they have a two hour window). She won't leave her room and engage in any activities and they are aware of the constant demands on me. A spot she might get on her shirt puts her in a meltdown until she gets me to come there and assure her I will work on the stain- she demands I do her laundry and wants a complete bedding change 4 times a week. These behaviors are the reason for the med change, but I was just surprised given how it's not recommended for those with kidney disease and dementia. Sometimes I feel like I don't know the timeline of things because she just seems like "mom" to me... she's always been demanding and compulsive about her surroundings and routines.. in your experiences is this any indication of their overall summation of her lifespan?